Research

Update on Primary Care Performance Assessment

The Primary Care Performance Assessment Project involves primary care physicians in the development of evidence-based practice assessment tools, including quality indicators for preventive care, screening and health promotion, management of acute and chronic conditions, and practice organization and management. A complete description of the Project can be found in the May/June 2003 issue of Newsbytes. The research team has been very busy over the summer engaging in research collaboration and knowledge transfer (dissemination) activities, including the preparation of three papers for presentation at four conferences this fall.

Cross-sectoral and International Collaboration and Dialogue

The Primary Care Project Team is involved in ongoing dialogue with a project to promote Cross-sectoral Accountability for Chronic Patients. The project team includes Dr. Georgina Feldberg (Principal Investigator, York University), Dr. Peter Coyte (Co-Principal Investigator, HPME) and Dr. Wendy Young (CHSRF/CIHR Postdoctoral Fellow, HPME). For information about this study, email Dr. Young at wendy.young@utoronto.ca. Both research teams share mutual interests in the areas of coordination of care, particularly information transfer, performance indicators and research transfer by workshop delivery.

Visiting Brazilian physician primary care researchers, Dr. Silvia Takeda and Dr. Luis Ferando Rolim Sampero, met with Primary Care Project researchers Dr. Yves Talbot (Co-investigator, Department of Family and Community Medicine, Mount Sinai Hospital) and Dr. Jan Barnsley (Principal Investigator) to discuss possibilities for shared learning. Dr. Takeda and Dr. Sampero have been invited to attend research team meetings to explore the development and use of primary care performance indicators in Brazil. Dr. Talbot is the Program Director of the Department of Family and Community Medicine's International Programs and has been working in Brazil, in conjunction with its Brazilian partners, since 1994 to strengthen understanding about family health and the role of primary care in securing and maintaining health.

Fall Conference Presentations

Primary Care Performance Indicators: Data Quality and Performance Measurement, by Jan Barnsley (PI), Whitney Berta, Jeff A. Bloom (UHN, Toronto Western Hospital Division and Dept. of Family & Community Medicine), Rhonda Cockerill, Liisa Jaakkimainen (S&WCHSC, ICES and Dept of Family & Community Medicine), Yves Talbot (Mount Sinai Hospital, Dept. of Family & Community Medicine), Eugene Vayda (Professor Emeritus) and Judith MacPhail (Project Coordinator), was accepted at the following conferences:

• Agency for Healthcare Research and Quality and Academy Health's 5th International Conference on the Scientific Basis of Health Services: Global Evidence for Local Decisions on September 20,2003 in Washington DC.
• Family Medicine 2003 Forum October 24, 2003 in Calgary AB sponsored by the College of Family Physicians of Canada.
• The 20th International Conference of the International Society for Quality in Health Care, Dallas Texas, November 2-5, 2003.

The following papers related to primary care research have been accepted at the 31st North American Primary Care Research Group Annual Meeting, October 25-28, 2003 in Banff AB.

• Designing a model for collaborative health care delivery: chiropractic services and primary care networks, by Mior Sil A, Barnsley J, Ashbury F, Boon H, Haig R, & Abeygunawardena H.
• Analyzing the role of the project manager in implementing a research study, by Judith MacPhail.

For more information about the Primary Care Performance Assessment Project, please contact Project Manager, Judith MacPhail.

Research and Teaching Profiles

Faculty associated with the Department of Health Policy, Management and Evaluation (HPME) are involved in a broad range of research activities with a variety of organizations. Success of the HPME Knowledge Transfer initiative is dependent on presenting our stakeholders with a unified, clear image of the depth and breadth of Departmental expertise. To promote greater internal awareness of the knowledge developed through HPME, faculty research profiles will be included as a regular feature of this newsletter.

This issue of the HPME newsletter features a research profile for Dr. Murray Krahn.

+ + PROFILE OF THE MONTH + +

Murray Krahn, MD, MSc, FRCPC

Dr. Krahn is an Associate Professor in HPME and the Associate Director of HPME's Clinical Epidemiology and Health Care Research Program. Dr. Krahn's major research interests include the application of decision analytic and clinical economic methods to problems of significance to the health system. Recent projects include development of a clinical policy model for prostate cancer, using administrative data to estimate long-term costs in prostate cancer and estimating the cost effectiveness of universal hepatitis A and C vaccination in Canada.

Education and Work Background

Dr. Krahn completed a Bachelor of Arts in Philosophy at the University of Winnipeg, a medical degree at the University of Manitoba and post-graduate training in Internal Medicine at the University of Toronto, where he also completed his MSc in Clinical Epidemiology. Past work experience includes a General Internal Medicine Fellowship at U of T and a Research Fellowship in Clinical Decision-Making at the New England Medical Center, Tufts University.

Apart from his role with HPME, Dr. Krahn is currently the Research Director of the Division of General Internal Medicine at the University Health Network; Associate Professor in the Department of General Internal Medicine and Clinical Epidemiology, University of Toronto; clinician researcher with the Division of Clinical Decision-Making and Health Care, Toronto General Research Institute, University Health Network; and a member of the clinical team at The Prostate Centre, a multi-disciplinary treatment facility in downtown Toronto.

Dr. Krahn's other professional responsibilities include membership on the CIHR Clinician Scientist Committee, WHO Task Force on Neck Pain and Associated Disorders, Cancer of the Liver Italian Program (CLIP) Data Safety and Monitoring committee, UCLS-Rand Evidence Based Practice Center Decision Analysis Group, and the University of Toronto Medical Journal Faculty Advisory Board. He is a peer reviewer for a numerous journals, including the Annals of Internal Medicine, Journal of the American Medical Association, CMAJ, Medical Decision Making and PharmacoEconomics.

Research Activities

Dr. Krahn is the principle investigator (PI) and co-investigator in a number of studies which examine the application of decision analysis, economic evaluation or utility assessment with respect to a various disorders, such as prostate cancer and hepatitis. Dr. Krahn is currently the PI of the following peer-reviewed studies, funded by CIHR and the National Cancer Institute of Canada:

• Population-based Estimates of Cost and Quality of Life in Prostate Cancer Survivor
• Preference Functions for a Health State Classification System for Prostate
• Development and Validation of a Utility Instrument for Prostate Cancer
• Comparison of Population-weighted Generic Utility Instruments to Direct Utility Assessment in Prostate Cancer Patients
• Using Policy Models to Improve Resource Allocation in Health: Studies in Prostate Cancer and Viral Hepatitis

Dr. Krahn is also involved with the Canadian Space Agency in a study on the cost-effectiveness of a decompression chamber for use in the international space station. One of Dr. Krahn's most controversial papers, Screening for Prostate Cancer: A Decision Analytic View, suggests that screening for prostate cancer may reduce overall health. This article has been widely cited and generated intense media attention.

Teaching and Supervisory Responsibilities

Dr. Krahn teaches and guest lectures in a number of graduate health courses, including, Medical Decision and Cost-Effectiveness Analysis, Cancer Epidemiology and Health Economics I (taught by Dr. Audrey LaPorte). He is course director for Decision Modeling for Clinical Policy and Economic Evaluation (II), and co-director of Medical Decision and Cost-Effectiveness Analysis. He sits on student thesis committees and supervises students at the undergraduate, master's, PhD and post-doctoral level. As the Associate Director of the Clinical Epidemiology and Health Care Research Program, Dr. Krahn is an active member of the program's executive committee, as well as a member and chair, respectively, of the MSc and PhD Admissions Committees.

Future Research

Future research interests include using decision analytic policy models as a central organizing framework for a body of empirical research into health outcomes in prostate cancer and viral hepatitis. In particular, he is interested in developing methods to use administrative data to develop disease specific longitudinal cost models, as well as conducting population-based studies of costs and preference-based health outcomes.

<<Previous Item

Table of Contents

Next Item>>